Basic Information
| Provider Information | |||||||||
| NPI: | 1386056075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER ORTHOPAEDIC AND SPORTS MEDICINE ASSOCIATES, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3809 W CHESTER PIKE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190732331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103595664 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1088 WEST BALTIMORE PIKE, SUITE 2302 | ||||||||
| Address2: | RIDDLE MEMORIAL HOSPITAL HEALTHCARE CENTER II | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105653145 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2014 | ||||||||
| LastUpdateDate: | 05/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | MALUMED | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6103595664 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.